Randomized trial of hydroxyethyl starch versus gelatine for trauma resuscitation

Background: Previous studies have demonstrated the rapid increase in system ic capillary permeability after blunt trauma and its association with poor outcome, There are theoretical advantages in resuscitation with colloid flu ids, which are well retained in the vascular compartment during times of ca pillary leak, The aim of this study was to compare the effects of post-trau ma resuscitation with hydroxyethyl starch (HES) (molecular mass, 250 kDa) o r gelatine (molecular mass, 30 kDa), the hypothesis being that HES would re duce capillary leak. Methods: Forty-five patients suffering blunt trauma mere randomized on admi ssion to receive either gelatine (Gelofusine) (n = 21) or HES (Pentaspan) ( n = 24) for the first 24 hours, after which the choice of fluid was at the discretion of the clinician. The mean Injury Severity Score fur the HES and gelatine groups were 20.0 (range, 9-41) and 18.1 (range, 9-32), respective ly (p = 0.43). Capillary permeability was assessed by urine albumin excreti on rate for the first 24 hours. For 5 days the daily mean PO2/FIO2 ratio, s erum C-reactive protein, hemoglobin, white cell and platelet counts, prothr ombin, and activated partial thromboplastin time were recorded. Results: Capillary permeability was lower in HES-treated patients during th e first 24 hours. Log mean (95% confidence interval) albumin excretion rate for gelatine and HES groups at 6 hours were 117.5 (84.9) and 46.8 (24.3) m u g/min (p = 0.011), at 12 hours were 54.9 (30.0) and 17.2 (7.6) mu g/min ( p = 0.001), and at 24 hours were 50.5 (23.4) and 23.6 (16.3) mu g/min (p = 0.030), respectively. The mean (95% confidence interval) PO2/FIO2, ratio fo r the HES and gelatine groups 48 hours after admission were 324 (44) and 26 7 (43) mm Hg, respectively (p = 0.03), The mean (95% confidence interval) s erum C-reactive protein in the HES and gelatine groups 24 hours after admis sion were 72.4 (19.2) and 105.7 (30.1) mg/L, respectively (p = 0.03), There were no significant differences in any of the hematologic parameters durin g the first 48 hours. Conclusion: The results suggest that compared with gelatine, resuscitation with BES reduces posttrauma capillary leak.